21 mmHg.The side effects,IOP and application of anti-glaucoma drugs were examined 1 h,1 d,1 week,1 month,3 months and 6 months after SLT. Results The IOP was significantly decreased 1 week,1 month,3 months and 6 months after SLT compared with that before treatment(P21 mmHg using two anti-glaucoma drugs,respectively. Conclusion SLT is a safe and effective method for IOP control in early CPACG after treatment with laser peripheral iridoplasty and laser iridectomy.

Objective To evaluate the therapeutic effects of needling revision with mitomycin C(MMC) subconjuctival injection on early failed filtering blebs after trabeculectomy for glaucoma. Methods Needling revision with MMC 0.2 mL(0.04 mg) subconjuctival injection was performed on 86 eyes of 76 patients with failed filtering blebs 2 to 6 weeks after trabeculectomy for glaucoma.An average of 1.88 times of treatment was performed.The intraocular pressure(IOP),blebs and side effects were observed,and follow-up was conducted for 6 months. Results Two to six weeks after trabeculectomy,there were 50 eyes with thickened and focalized blebs,32 eyes with encapsulated blebs and 4 eyes with no bleb.Six months after needling revision with MMC subconjuctival injection,blebs of 61 eyes turned into functional ones.The blebs were thinned and multicysted in 24 eyes,diffused and elevated in 37 eyes,thickened and focalized in 6 eyes,encapsulated in 13 eyes and disappeared in 6 eyes.Three months after treatment,the mean IOP was(15.2?6.1) mmHg,and there were 57 eyes with IOP

Objective To discuss the technical points and clinical effects of thoracic reconstruction after resection of the sternal tumnors with autogenous rib graft and pedicle oinental flap. Method A retrospective study was made on 12 patients,who underwent resection of sternal tumors and thoracic reconstruction with autogenous rib graft and pedicle omental flap between January 2004 and March 2010. The tumor involved the manubrium in 4 patients and the sternal body in 8 patients. Results All operations of 12 patients were succeed with no perioperative mortality or severe complications. Incisions healed by primary intention healing,and no paradoxical breathing was found. The postoperative period was uneventful.Conclusion It's an effective way to treat sternal tumors by the resection and thoracic reconstruction with autogenous rib graft and pedicle omental flap.

Objective This study was designed to determine the influence of acute ethanol intoxication (AEI) on brain edema and aquaporin-4(AQP-4) levels after traumatic brain injury(TBI) in rots. The underlying mechanism was also investigated. Method Severe traumatic brain injury models were made using the Feeny method; acute ethanol intoxication models were established by gavagy. One hundred and ninety-two male SD rats were randomly divided(random number) into four groups, namely the sham operation group(A ), the acute ethanol intoxication group( B ), the traumatic brain injury group(C) and the combination of acute ethanol intoxication with traumatic brain injury group(D). Each group was further divided into four sub-groups according to the time interval between injury and death of the rats. After brain tissue was fixed by affusing paraformaldehyde, the expression of AQP-4 was detected by immunohistochemistry. Water content was detected by dry-wet analysis, and AQP-4 mRNA and protein were detected by RT-PCR and western blotting respectively after the brain tissue was got by rapid decapitation. Data were analyzed by one-way ANOVA. Results The water content of brain tissue and expression level of AQP-4 were not significantly different between groups A and B( P > 0.05); however both were significantly increased in groups C and D relative to group A( P < 0.05). The water content of brain tissue in group D increased by mere than that in group C( P < 0.05), while the expression level of AQP-4 in group D was lower than that in group C(P<0.05). Conclusions Acute ethanol intoxication inhibited the expression of AQP-4,which induced a more severe cerebral edema after traumatic brain injury.

Objective To investigate the differences between animal temperature controller (ATC) and artificial climate chamber (ACC) used for the establishment of classical heat stroke (CHS) rat model.Methods Twenty-four male specific pathogen-free Wistar rats were randomly (random number) and equally assigned to three groups,namely room temperature control (C-C) group,heat stroke under conscious state (HS-C) group,and heat stroke under anesthesia (HS-A) group.Rats of HS-C or HS-A group were placed into ACC or ATC,then exposed to 35 ℃ heat stress.The systolic blood pressure (SBP) and core body temperature (Tc) were monitored.The time required for onset of HS was recorded.The white blood cell count (WBC) in peripheral blood and serum levels of C-reactive protein (CRP),tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) were measured.The histopathological changes of major organs were also confirmed by hematoxylin-eosin (HE) staining.Results The onset time in HS-A group was significantly shorter thanthatin HS-C group [(40.0 ± 4.3) minvs.(110.1 ± 5.3) min,P＜0.01].The SBP and Tc at this moment were lower in HS-A group [(159.1 ± 5.91) mmHg vs.(174.54 ± 5.77) mmHg,P＜0.01;(43.5 ± 0.4)℃ vs.(44.4 ± 0.2)℃,P＜0.01].TheWBC,CRP,TNF-α and IL-1 β levels of these two HS groups were dramatically elevated compared with C-C group (P ＜0.01).The inflammatory cytokines levels in HS-A group were significantly lower than those in HS-C group (P ＜ 0.01),but there was no difference in WBC between them (P ＞ 0.05).However,there was no obvious difference in histopathological change in major organ observed between HS-A and HS-C groups.Conclusions In comparison of these two methods,ATC is similar to ACC in respect of the establishment of CHS rat model.ATC is quicker in onset of HS,and more simplified and economical than ACC and could substitute ACC.

Objective To investigate the effects of ligustrazine (TMP) combined with salvia miltiorrhiza on the progression of chronic allograft nephropathy (CAN) in rats and the action mechanism.Methods Fischer 344 rats and Lewis rats were used as renal transplant recipients and donors for ortlotopic kidney transplantation. The CAN model was established.By using random number table,the kidney transplant recipients were divided into five groups:cyclosporine A (CsA) group (A),TMP + CsA group (B),Salvia + CsA group (C),TMP + Salvia + CsA group (D) and blank control group (E,receiving no treatment).At 2nd,4th,6th,8th and 12th week after operation,5 mice in each group were sacrificed,and the transplanted kidney was removed for examination of renal histopathological changes. The immunohistochemistry was used to detect the expression of transforming growth factor β1 (TGF-β1) in the renal allograts,and by using fluorescent quantitative polymerase chain reaction,TGF-β1 mRNA expression in the renal allograts assayed.Results In blank control group,the survival time was no more than two weeks.In group A,the CAN pathological changes occurred at 4th week postoperation,those in group B and group C occurred later than in group A,and latest in group D with mild pathological lesions.In all groups after operation,Banff scores showed an upward trend,and at the same time point,those in group A were significantly higher than groups B,C and D ( P＜0.05 and P＜0.01 ).and those in group D was significantly lower than in group B and group C (P＜0.05),but no significant difference was found between group B and group C (P＞0.05).With time over,the TGF-β1 expression intensity showed an increasing trend.At the same time point,TGF-β1 expression intensity in group A was strongest among groups A,B,C and D (P＜0.05 and P＜0.01 ),and that in group D was significantly lower than in group B and group C (P＜0.05),but no significant difference was found between group B and group C (P＞00.05).The changes of TGF-β1mRNA expression pattem in each group showed the same trends as TGF-β1 protein expression.Conclusion TMP or salvia miltiorrhiza can delay the progression of CAN in kidney transplant rats by down-regulating the TGF-β1 expression,and the combined use of them exerts synergic effects.

Objective The use of extracorporeal membrane oxygenation (ECMO) as a treatment for the failure of cardiopulmonary function after cardiac surgery is increasing and has been reported to be 3% to 5% in the cases with congenital heart disease. We reviewed our experience with ECMO in children who received heart surgery for congenital heart disease and complicated with severe heart failure postoperatively. Methods Eight patients received ECMO, seven was due to the failure to wean from bypass and one had fulminant myocarditis. Import membrane oxygenator,veno-arterial mode ECMO and right atriumascending aortic cannulation were used in 7 cases and peripheral cannulation via femoral veno-artery route was used in 1 case.Supportive intervention persisted from 65 to 498 hours, with flow rate maintained at 80 to 120 ml per minute per kilogram body weight. Results Five patients died, with a mortality of 62.5%, and 3 cases discharged, with a survival rate of 38%. Bleeding occurred in 5 cases, thrombosis occurred in 2 cases, hemolysis was identified in 1 case and DIC was observed in 1 case.One case had liver failure and 2 cases had malnutrition. Oxygenator plasma leakage occurred in 2 cases. Mean arterial blood pressure increased significantly after the establishment of ECMO as compared with that before the procedure [( 60.2 ± 7.8 )mmHg vs. (48. 1 ± 5.2 ) mmHg, P≤0.05]. The arterial concentration of lactate decreased significantly, from (5. 1 ± 0. 8 )mmol per liter before ECMO to ( 3.6 ±0. 5 )mmol per liter after ECMO, P ＜0.05. Conclusion For patients who survived the congenital heart surgery and no residual anatomic deformity, ECMO can be used as early as possible as a treatment for severe heart failure which resulted from coexistent of left and right ventricular and pulmonary insufficiency. An overall mortality may be decreased by ECMO technique as it plays a substitution role for gas exchange in the lung. As a result, the concentration of oxygen and the airway pressure used during ventilation, and the resultant lung injury can be reduced. Appropriate strategies involve transfusion of fresh platelet and packed red blood cells, replacement of frozen plasma and blood products, as well as rational use of vasoactive drugs and heparin, and maintaining a stable internal environment. Following strategies are also recommended: using continuous arterio-venous hemofiltration and durable heparin-coated membrne oxygenator, reducing hemorrhagic complications, monitoring pressure on both side of the film, identifying plasma leakage carefully and reducing the mechanical complications.

Objective To investigate the impact of optimal respiratory system dynamic compliance (Cdyn) strategy for titrating positive end-expiratory pressure (PEEP)on the prognosis of acute respiratory distress syndrome (ARDS) in infants.Methods A total of 30 patients with ARDS admitted in Pediatric Intensive Care Unit (PICU) of Guangxi Maternity and Child Health Hospital were divided into 2 groups randomly (n =15).PEEP was set in the control group according to PEEP/FiO2 in American ARDS collaboration while optimal Cdyn was for the treatment group.Pressure control ventilation(PCV) mode and small tidal volume(7 mL/kg)strategy were taken.Respiratory mechanics,hemodynamics and inflammatory cytokines were monitored in each group before and after experiment.The time of assisted ventilation,and the hospital stay in PICU and 28-day mortality were compared.Results (1) There was no significant differences in gender,age and severity of disease between the 2 groups (all P ＞ 0.05).(2) The optimal PEEP of the control group was significant lower than that of the treatment group[(6.4 ± 1.4) cmH2O vs (9.9-± 1.6) cmH2O,P ＜ 0.01].(3) Cdyn and oxygenation index(OI) in 2 groups were all improved,and the degree of improvement in the treatment group was significantly better than that of the control group [Cdyn after the experiment at 2 h:(0.39 ± 0.03) mL/(cmH2O·kg) vs (0.36 ±0.03) mL/(cmH2O · kg),P＜0.05; 24 h:(0.40±0.03) mL/(cmH2O · kg) vs (0.38±0.03) mL/(cmH2O · kg),P ＜0.05; 48 h:(0.43 ±0.02) mL/(cmH2O · kg) vs (0.40 ± 0.02) mL/(cmH2 O · kg),P ＜ 0.01 ; OI after the experiment at 24 h:(20.07 ± 2.12) cmH2O/mmHg vs (21.94 ± 2.05),P ＜0.05 ; 48 h:(17.51 ± 1.64) cmH2O/mmHgvs (19.82 ± 2.07) cmH2O/mmHg,P ＜ 0.01] ; There were no significant differences in heart rate(HR),mean aerial pressure(MAP),cardiac index (CI) before and after the experiment (all P ＞ 0.05).(4) Interleukin-6 (IL-6) in two groups all decreased gradually,and the decrease in treatment group was more obvious than that of control group after the experiment at 24 h:(84.58-± 9.11) ng/L vs (93.18 ± 9.27) ng/L,P ＜ 0.05 ; 48 h:(76.67 ± 9.23) ng/L vs (90.10-± 9.42) ng/L,P ＜ 0.01.(5) The lengths of assisted ventilation and the hospital stay in PICU of the treatment group were significantly less than that of the control group [length of assisted ventilation:(6.62 ± 1.26) d vs (8.06-± 1.44) d ; the hospital stay in PICU:(8.12 ± 1.31) d vs (9.53 ±1.42) d,all P ＜0.05].There had no barotrauma and the mortality was not distinct between the two groups(P ＞ 0.05).Conclusions Optimal Cdyn method for titrating PEEP improves respiratory mechanics of ARDS obviously,shortens the time of assisted ventilation,and has no serious adverse effect on hemodynamics.

Objective To investigate the clinical application of mobile ICU in long distance inter-hospital transportation of critically ill children.Methods The clinical data of 467 critically ill children admitted in the mobile ICU for long distance inter-hospital transportation during Jan 2011 to Dec 2013 were studied retrospectively.Results A total of 467 critically ill children were transported from 27 hospitals of the counties and cities around Nanning.Of these 467 cases,295 cases were male and 172 female,with ages from 29 days to 11 years(median age was 10 months) and weights from 2.5 to 40.0 kg(median weight was 8.3 kg).The transport distances were from 68 to 436 km(median distance was 157 km);the transport durations ranged from 1.5 to 13.0 h(median duration was 5.3 h),and the average pediatric clinical illness score was 83±10.Of these 107 cases(22.9%,107/467) who required first aid before transfer,63 cases(58.9%) were treated with endotracheal intubation while 26 cases(24.3%) with anti-shock therapy.All the 467 cases received sustained electrocardiographic,blood pressure,blood oxygen saturation monitoring and rehydration therapy for maintaining stable internal environment during the transportation,with 341 cases(73.0%) of them received sedative or analgesic treatment,185 cases(39.6%) received mechanical ventilation,15 cases(3.2%) received high doses of vascular active drugs.All the critically ill children were admitted to our Critical Care Department through the green channel.The vital signs improved significantly than those before transportation[heart rate:(143±19)times/min vs.(165±24)times/min;mean arterial pressure:(76±5)mmHg vs.(71±4)mmHg,1mmHg=0.133 kPa;SpO2:(95±2)% vs (92±2)%;pH:7.37±0.04 vs 7.34±0.03;lactate:(2.5±0.2)mmol/L vs (2.8±0.3) mmol/L].There were significant differences between before and after the transportation(P＜0.01,respectively).Conclusion Mobile ICU is propitious to treat the critically ill children energetically and effectively in long distance inter-hospital transportation and ensures the safety.It is worth promoting.

To study the clinical skills training methods and formulate a training objective for pediatric long-year-program students, to let the students, through three years of training program, reach the clinical ability as a chief resident, with better laboratory research skills, teaching awareness and responsibility, and also with good comprehensive quality and excellent English, and finally become clinical talents with great potential and innovation, this report summarized our study results of training two terms of long-year-program pediatric graduates, who fully meeted the training objectives in the department's practice.